# Renal Involvement in Cancer Patients Undergoing Oncology Therapies: Implications for Personalized Treatment Strategies

## TL;DR

This study shows that cancer treatments, especially immunotherapy, often cause kidney damage, highlighting the need for personalized treatment plans involving both oncologists and nephrologists.

## Contribution

The study reveals a high incidence of kidney injury in cancer patients and emphasizes the importance of multidisciplinary care to manage treatment-related renal toxicity.

## Key findings

- Acute kidney injury (AKI) occurred in 61.4% of patients, and chronic kidney disease (CKD) in 25.7%.
- Immunotherapy patients had significantly higher blood urea nitrogen and creatinine levels compared to those on traditional therapies.
- Patients with immune-related adverse events (irAEs) had a much higher rate of treatment discontinuation compared to those without irAEs.

## Abstract

Introduction: Oncological therapies have significantly improved patient outcomes but are increasingly associated with renal toxicity, which can markedly influence therapeutic decisions. Integrating early identification of kidney injury into clinical workflows is essential for personalized medicine, allowing treatment tailoring based on individual risk profiles. Aim: To evaluate the incidence of acute kidney injury (AKI) and chronic kidney Disease (CKD); assess indices of renal function recovery in patients who developed AKI; and investigate the incidence of renal immune-related adverse events (irAEs) in patients receiving immunotherapy. Materials: Renal function, serum electrolytes, inflammatory markers, blood gas analysis, and urinalysis were evaluated at baseline before oncological therapy (T0), after approximately 2 weeks (T1), and after 3 months (T2). Results: Seventy patients were analyzed (median age 71.5 years). AKI occurred in 43 patients (61.4%) and CKD in 18 (25.7%). Patients receiving immunotherapy displayed significantly higher blood urea nitrogen (p < 0.01) and creatinine (p < 0.01) levels compared to those undergoing traditional therapies (targeted therapy and chemotherapy). Treatment discontinuation was required in 14 (56%) immunotherapy patients versus 7 (19.4%) receiving traditional therapy (anti-VEGF and cisplatin) (p < 0.01). Among 25 immunotherapy-treated patients, 13 (52%) developed immune-related adverse events (irAEs). Patients with irAEs predominantly experienced AKI (92.3%), whereas those without irAEs showed both AKI and CKD (44.4%) (p < 0.01). Treatment discontinuation occurred in 84.6% of patients with irAEs compared to 11.1% without irAEs (p < 0.001). Conclusions: We showed a high incidence of AKI and CKD among cancer patients; in particular, the majority of patients receiving immunotherapy presented irAEs. CKD also occurs in association with comorbidities, such as previous use of NSAIDs, investigations with contrast agents and episodes of AKI on CKD determined by drugs. It seems necessary for there to be multidisciplinary collaboration between oncologists and nephrologists to individualize treatment plans; thus allowing the non-suspension of therapy, which positively influences the prognosis of patients.